In human patients undergoing abdominal surgery, Gram-positive bacteria and/or Gram-negative bacteria, which are normally present in the intestine, can cross the intestinal wall and reach the circulation. During surgery and/or preceding surgery, conditions such as fasting and ischaemia can be present which facilitate the bacterial translocation. In addition, the surgical procedure itself may result in a disrupted intestinal barrier, particularly during abdominal surgery. This translocation results in short and midterm complications including sepsis, bacteraemia, and endotoxaemia. Peritonitis, which is an inflammation of the peritoneum, also can result as a consequence of infection by microorganisms residing within the intestines which can be released during a surgical procedure.
Sepsis (or septic shock or septicemia) is a disorder which occurs when a relatively large amount of micro-organisms, or fragments thereof, enter the body. It is characterized as a systemic disease associated with the presence and persistence of pathogenic micro-organisms or their toxins in the blood. The presence of endotoxins, such as lipopolysaccharide (LPS), lipoteichoic acid (LTA) and/or peptidoglycan (PG), in the blood gives rise to a condition known as endotoxaemia or endotoxic shock. When the micro-organisms which have entered the blood are viable, this condition is also referred to as bacteraemia.
The intestine, especially the colon and the lower part of the small intestine, is a reservoir of LPS and Gram-negative bacteria, such as the common inhabitant Escherichia coli, but also of LTA, PG and Gram-positive bacteria. The presence of Gram-negative and/or gram-positive bacteria and/or LPS and/or LTA and/or PG in the gut does not create any issues for a healthy individual. However, upon increase of the intestinal permeability or decrease of the intestinal integrity during or after surgery, this can become a problem. Sepsis, bacteraemia and/or endotoxaemia lead to a prolonged hospital stay and thus increased costs and increased morbidity. It can also lead to multiple organ failure or even death. It is, therefore, of great importance to find a method to treat, and especially to prevent bacterial translocation and resulting infection during or shortly after surgery.